Viral Encephalitis Outbreak - Chronology of Events

Viral Encephalitis Outbreak
- Chronology of Events
documented by Pahlawan Volunteers

Viral Encephalitis BattleGround

Chinese version

Voice of Pahlawan

January 1997

Jan 12, one farm worker from Perak Ampang area, admitted to hospital diagnosed viral encephalitis. Patient subsequently recovered.

October 1997

First mysterious death of farm worker from Leong Sin Nam Farm.

February 1998

2-3 farm workers came down with disease, confirmed viral encephalitis.

September 1998

Outbreak of what was then described as JE in Ipoh.

October 1998

Outbreak of viral encephalitis in Perak. Fatality reported in horses, pigs and pig farm worker in Ulu Piah.

More people working in pig farms become sick. Pigs developed mental excitation with pulmonary involvement; pink froth coming from the nose then died.

Medical personnel convinced it is JE.

Suspicion: The epidemiological implication of JE does not fit as only the healthy strong age group came down with the disease.

November - December 1998

Nov 4, Health Minister Datuk Chua Jui Meng announced that the disease was JE. Also said that there was enough local expertise to contain it by way of destroying the mosquitoes and vaccination of the high risk group.

Nanyang Siang Pau carried story alleging that JE is not the cause of deaths.

Sikamat (near Port Dickson) 5 human victims. JE diagnosed although victims are adults having physical contact with pigs, their families consist of children and old people did not succumb to JE.

Pigs observed by vet - severe respiratory signs, flu like illness in pigs and humans, then outbreak occurred.

Nov 27, Health Minister Datuk Chua Jui Meng quoted as declaring JE under control.

Private veterinarians informed DVS of their suspicion that it is not JE, and suspected something else. They also informed FLFAM and MSEA.

January 1999

Jan 6, 2 cats and 9 dogs reported dead by farmers in Sikamat.

February 1999

Feb 24, Regional Conference on Latest Advances in the Diagnosis and Control of Japanese Encephalitis (Syuen Hotel, Ipoh), organized by Veterinary Association Malaysia and Ministry of Health and Ministry of Agriculture.

Dr Henry Too from UPM (and at least three other participants) questioned the JE diagnosis during the question and answer session. Datuk Dr Tee Ah Sian from the Ministry of Health defended the JE diagnosis. According to Dr Too, Kinta District Health Office Dr Marina Ab Hamid commented on some puzzling aspects of the epidemiology.

Feb 28, Institute of Medical Research (IMR) and Veterinary Research Institute (VRI) confirmed that the cases were JE as they said samples for testing were sent to Japan.

February - March 1999: Progression of Disease

During Chinese New Year holidays, sudden onset of outbreak in Sungai Nipah, spread to Kampung Sawah and Kampung India. Bukit Pelanduk worsened.

Mar 23, spread to Sepang.

Abnormal clinical signs in sows and the boars. Attending vets noticed:

Sudden onset of respiratory and nervous signs on pigs of all ages.
Sows --heavy breathing/loud coughing which can be heard far away.
Sows and boars showed great distress shaking their heads violently and bang head against pens.
Frothy/bloody discharge from the nose or mouth before dying.
Blood does not clot completely.
A few dead sows having flatulence.
Some farmers’ dogs and cats, and many rodents were found dead.

Necropsy findings on the dead sows:

Enlarged and hemorrhagic cervical and submandibular lymph nodes resembling of Classical Swine Fever but no splernic infarct.
Pulmonary congestion and hemorrhages as seen in Actionobacillus Pleuropneumonia
The brain and meninges congested
Hydrothorax
In younger pigs the consistent lesions are congested brains.
However illness subsides very fast, some sows recovered and the other age group pigs look fine.
FLFAM led by President Lee Ah Fatt held numerous dialogues with Health Minister Datuk Chua Jui Meng, repeated his suspicion that JE is not the cause of the problems. Lee Ah Fatt was told by the Minister no evidence to suggest otherwise.

March 1999

Mar 2, residents flee their villages - Jimah PFA and Sungai Nipah. Since panic started Feb 28 1999, some 10,000 people left the area.

95% of Sungai Nipah's 1075 residents fled.

300 farmers in Bukit Pelanduk demonstrated on its main street complaining of the Ministry of Health and Agriculture's inaction to protect the farmers from the viral encephalitis attack.

Health Ministry's JE Operation Center urged residents in Sungai Nipah not to panic and flee because of JE.

Mar 3, Nanyang Siang Pau: Media Control Superintendent Abdullah Daud said JE in Sungai Nipah under control, villages need not move out.

Mar 4, Sin Chew Jit Poh headline Health Minister Datuk Chua Jui Meng advised farmers slaughter the infected pigs and put them on the market.

Mar 5, following massive fogging, culling and allowing live pigs to leave the Jimah PFA, farmers and residents began to return to their village.

Mar 6 and within 2 weeks, Kg Sawah Lam family lost four family members.

Mar 6, Federation of Chinese Assemblies Malaysia (FCAM) urged the varioius governments to coordinate their efforts in helping the high risk area victims.

Mar 7, Bukit Pelanduk residents, farmers and businesses raised RM100,000 to buy fogging equipment to conduct massive destruction of mosquitoes in the area.

Mar 8, pig farmer Yong Chiew Keng (33) took his own life because of huge losses incurred as a result of the crisis.

Mar 9, Health Minister Datuk Chua Jui Meng visited Bukit Pelanduk.

Mar 10, pig farmer Su Ying San and his brother, both from Sungai Nipah went back to bury dead animals in his farm. Some one hundred piglets of his farm died suddenly, with very scary clinical signs.

Su Yin San came down with the disease and passed away Mar 16. His brother also came down with fever, but recovered after taking medicine.

Mar 11, FCAM appointed its deputy President Datuk Pheng Hin Huah to liase with the Ministers concerned, to curb the spread of JE and assist the pig farmers.

Mar 12-14, Taiwanese experts Prof Dr Rea-min Chu and colleague came to Malaysia at the invitation of FLFAM. Recommended strict disease surveillance controls, immediate and speedy culling of pigs and other animals in the affected areas. Taiwanese experts could not obtained samples for testing.

Mar 15, MSEA President Lee Po Yu passed away, diagnosed viral encephalitis.

New virus found by Malaysian researcher Dr Chua Kaw Beng in his tests and broken cells found in deceased humans samples. Dr Chua took sample for testing at Center of Disease Control (CDC) in Atlanta.

Private veterinarians’ advice to farmers to take precaution stopped by Department of Veterinary Services officials.

Mar 16, A delegation from FCAM led by its president Datuk Chong Chin Shoong met with Health Minister Datuk Chua Jui Meng and Agricultural Minister Datuk Amar Dr. Sulaiman daud, expalined to them the dilemma faced by the pig farmers and submit a memorandum requesting immediate action to be taken to assist the pig farmers. Datuk Chua and Datuk Sulaiman promised FCAM, the issue will be discused in the next day cabinet meeting.

Mar 17, Datuk Chua informed FCAM, Cabinet has agreed to set up a special Task Force consists of 6 ministries to deal with the JE problem. On the same day leaders of FCAM and Datuk Chua visited Seremeban General Hospital and listened to a briefing given by health officers.

Mar 17, CDC Atlanta confirmed the presence of a Paramyxovirus Hendra-like virus from samples by Dr Chua Kaw Beng. Dr Chua confirmed JE cases limited to 30% out of the total. Unconfirmed patients CSF and nervous tissue sample were inoculated, 5-6 isolates in Vero 6 cells were observed with cytophathic effect (CPE) which were atypical of Japanese Encephalitis. More features of Paramyxovirus with giant cells and syncithia (cell fusion) formation.

When tested against human viruses, which included measles, RSV etc, results were non-reactive.

Electron microcopy and spot slides at Fort Collins showed mimic Paramyxovirus (Pleomorphic nucleocapsid and enveloped RNA virus).

Staining with arbovirus groups was non-reactive.

Collaborative work being done by other collaborative agency in Australia.

Initial tests with primers of Hendra failed. When more appropriate primer with a broader type were used, PCR detected Hendra-like virus. Sequency of the p Gene with 140 bp (base of RNA) showed 12 of these were dissimilar from Hendra. The sequence obtained from the 2 human specimens was identical. The nuclear capsid has 10% dissimilarities. Later, 14 out of 17 samples were tested positive under IgM capture test for Hendra. Only 1 case was JE positive.

Mar 19, Bukit Pelanduk residents started massive evacuation from their village.

Health Superintendent Tan Sri Abu Bakar revealed that out of 30 deaths (suspected of JE), a new virus, a member of the Paramyxovirus family was found in five of their spinal fluids.

Mar 20, Nanyang Siang Pau, authorities forced their way in to 2 pig farms in Port Dickson, culled the pigs, after which pigs were buried right in front of pig farmer’s house. Health Minister Datuk Chua Jui Meng and Ong Ka Ting arrived later and after realizing that this is not an infected area, stopped the culling operation.

Mar 20, Singapore banned import of life pigs from Malaysia.

Mar 20, Pahlawan, a group of concerned citizens sent letter to the Prime Minister, urging the PM to view the matter as National Health Emergency.

Mar 22, FLFAM and MAFAV sent joint letter to PM with copy to Minister of Agriculture and Minister of Health on the urgency of the situation.

6 Chinese Community organizations sent a joint memorandum to the PM

Mar 23, FLFAM and Chinese Community leaders met with Health Minister Chua Jui Meng. Datuk Chua agreed to stop vaccinating pigs in non affected areas, and co-opted Dr Henry Too and Lee Ah Fatt into the task force.

Private veterinarian met with Dr T G Ksiazek from CDC. Confirmed their suspicions and agreed with private veterinarian on their measures to control the disease.

Mar 24, Cabinet Meeting, Prime Minister upgraded crisis to national disaster level, reconstituted the Task Force, appointing Deputy Prime Minister Abdullah Ahmad Badawi as chairman with a ten cabinet minister committee to “use all resources” to contain the spread.

Early morning Mar 25, MAFAV and FLFAM’s joint disease containment proposal went to all Chinese ministers.

Mar 25, FLFAM Lee Ah Fatt, Dr Henry Too, Dr Kok Poh Chu and Pahlawan Foong Wai Fong attended the Task Force meeting chaired by DPM. Lee Ah Fatt and Foong Wai Fong proposed the culling of all animals and made the case that compensation is important for disease control.

Chinese Community leaders Tan Sri Ngan Ching Wen, Lim Guan Teik and Tan Kai Hee met with DPM on issues of right assistance to the farmers. DPM revealed a RM60 million fund for vaccination and cleaning up.

Mar 26, Sin Chew Jit Poh: DVS Director General Dr Mohamad Noordin said authorities stopped vaccinating pigs in the unaffected areas two days ago.

Mar 26, 6 Taiwanese experts arrived, led by Prof Dr Rea-min Chu.

Mar 28, FLFAM and MAFAV disease containment proposal refined by Taiwanese experts submitted to DPM and Transport Minister Ling Liong Sik.

Mar 29, Taiwanese experts met with Transport Minsiter Ling Liong Sik while FLFAM and Chinese Community leaders met with DPM Ahmad Badawi –disease containment proposal version 1.3.

Private veterinarians Dr Mah and Dr Teo requested Tan Sri Ngan to buy 50 sets of P4 biosecurity protective clothing. Tan Sri Ngan agreed. (Note: cancelled as they were not required.)

Mar 31, steps for culling pigs by electrocution and carcass disposal guide (Courtesy of Dr Rae-min Chu) websites on up on the Internet by Pahlawan Pat Lu.

April 1999

Apr 1, Pahlawan Su Chin Hock experimented with the Taiwanese model of electrocution and succeeded. We await instruction from FLFAM to build prototype.

Apr 1, Tan Sri Ngan secured insurer for RM100,000 insurance for 500 volunteers.

Apr 2, a delegation from FCAM met with Deputy Prime Minister, appealed to the government to increase the compensation for putting down pigs and provide more assistance ot the pig farmers.

Apr 10, Health Ministry officially announced the naming of Nipah Virus after Sungai Nipah, the place where the virus was first discovered.

Apr 19, The Star: Bukit Pelanduk chicken died followed by goats and cows.

Apr 21, DVS Director General Noordin revealed that 2 dogs in Bukit Pelanduk are tested positive for Nipah virus.

Apr 24, Sin Chew Jit Poh: Cattle still roaming the streets of Bukit Pelanduk. (Note: Task Force ordered the culling of all animals in affected areas.)

Apr 28, Bernama: Menteri Besar Tan Sri Ramli Ngah Talib, confirmed to cull all 4,500 pigs infected with Nipah virus in a farm at Kampung Koboi, Gopeng, and another 4,000 at the Coldstream pig farm in Bidor within two weeks.

Apr 28, Government set up an Inter-ministerial Committee to handle viral diseases originating from animals such as the Hendra, Nipah and Japanese Encephalitis, rabies and other ailments.

Apr 29, Bernama: Over 100 dead pigs culled during the recent operations have yet to be disposed off, causing not only concern but foul smell - Agriculture Minister Datuk Amar Dr Sulaiman Daud's visit to Bukit Pelandok.

May 1999

May 1, Bernama: Health Ministry formed primary teams to carry out extensive medical follow-ups on Viral Encephalitis (VE) patients who had been discharged, especially those formerly infected with the Nipah or Hendra-like virus.

May 3, Bernama: Local and foreign experts collecting blood samples from dogs, cats, wildboar, cows, buffaloes, bats, goats, horses, rats and birds to establish whether they were carrying the deadly viruses. "So far dogs and cats in the affected areas have tested positive and two horses in Ipoh also had the deadly virus," Chua said.

May 4, Bernama: Rats being tested for deadly diseases while dogs and cats have been confirmed by health authorities to be carriers of the Nipah virus in recent blood tests, said Chua.

May 7, Bernama: All the 4,000 pigs at the Lee farm in Seelong, near Senai, will be culled after blood samples taken from the farm tested positive for the Nipah virus. Dogs and cats in the farm would also be put down said State Environment and Consumer Affairs Committee chairman Dr Chua Soi Lek.

May 7, Bernama: Stay away order for residents in JE/Nipah affected areas. Health Minister Datuk Chua said the 54 families evacuated earlier from Bukit Pelandok and Kampung Sungai Nipah and had returned home against the advice of the authorities, were only risking their lives. He said they might expose themselves to the Nipah virus and other infections resulting from the culling and burial of the pigs.

May 7, Bernama: Of the 258 JE and Nipah cases in the country, 127 patients have been discharged, 100 have died and 31 were still being warded. In Negeri Sembilan, of the 122 cases, 42 have died, 66 have been discharged while 14 are still warded.

May 9, Memorial Service for those who died fighting outbreak, organized by the Federation of Livestock Farmers Association and Save the Pig Farmers' Committee (Negri Sembilan) at Chung Hwa Independent School, Seremban.

May 10, The Sun: 40 pigs in Kampung Bunuhan, Tumpat (Kelantan) tested positive for viral encephalitis, reported by Tumpat district officer Mohamad Jamil Muhammad.